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Development of an Evaluation Tool to Assess Technical Skill in Laparoscopic Colorectal Surgery: A Delphi Approach
ASSOCIATION FOR ACADEMIC SURGERY AND SOCIETY OF UNIVERSITY SURGEONS—ABSTRACTS time. Research and improvement efforts should be undertaken that target these informal interactions.
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* P < 0.05 The operating room is a fixed cost although operative time is a variable cost. In our institution, OR time costs approximately $25/min. The cost associated with a complication is difficult to define. Conclusion: Surgical procedures are significantly longer with residents. In many instances, there are significantly more complications in procedures with residents. The financial cost associated with resident education includes an increased cost for procedures due to an increase in operative time and an increase in complications.
38.8. Development of an Evaluation Tool to Assess Technical Skill in Laparoscopic Colorectal Surgery: A Delphi Approach. V. N. Palter, H. M. MacRae, T. P. Grantcharov; University of Toronto, Toronto, ON, Canada
38.7. The Cost of Resident Education. C. S. Hwang,1 K. A. Wichterman,2 E. J. Alfrey3; 1Stanford University, Stanford, CA; 2The Springfield Clinic, Springfield, IL; 3Southern Illinois University School of Medicine, Springfield, IL Introduction: Previous studies regarding the cost of resident education are conflicting. Most studies regarding surgical residents report single procedure costs at one institution. The National Surgical Quality Improvement Program (NSQIP) database has allowed insight into defining cost disparities associated with resident education. Materials and Methods: We compared demographic data, and then outcome data that contributes to cost from the NSQIP database for five procedures commonly performed by residents from 2005-2006 between patients cared with and without residents. We compared age in years, ASA class I-VI, total operating room time (OR time) in minutes (min), length of hospital stay in days (d), number of patients with a return to OR in 30 d, and complications. Comparisons were made using the unpaired Student’s t-test. Differences < 0.05 were considered significant. The five cases compared were laparoscopic (L) and open (Op) appendectomy (Appy), elective laparoscopic cholecystectomy (L-GB), mastectomy (mast), and elective colon resection (colon) between the resident Ò and no resident (NR) groups. Results: There were 32,685 patients evaluated in these five cases. In all comparisons, OR time was significantly longer, in three comparisons complications were higher, and in one instance LOS was longer in the resident groups.
Introduction: Laparoscopic colorectal surgery (LCS) is considered an advanced minimally invasive procedure. The long, variable learning curve for LCS, as well as evidence that patient outcomes may suffer early in the learning curve, necessitates that individuals learning LCS do so in a safe manner, with a means to objectively evaluate their performance before entering independent practice. To date no tools have been designed and validated to assess performance during LCS. Furthermore, to be widely useful, any tool developed must be reflective of practice across many institutions. Objectives: To design an objective technical skills assessment tool for laparoscopic colorectal surgery using a Delphi consensus methodology. Methods: This study utilized a Delphi methodology to achieve consensus through expert opinion on the essential steps for a laparoscopic sigmoid colectomy and laparoscopic right colectomy. These sub-steps were compiled from three sources: 1) University of Toronto faculty expert opinion 2) surgical textbooks 3) published peer-reviewed literature. Each expert was asked to rate the sub-steps on a Likert scale from 1 (strongly disagree) to 5 (strongly agree) with respect to the level that they believed that the step should be included in a final evaluation tool. In addition, participants were offered the opportunity to comment on each sub-step, or to clarify their ratings. The average and standard deviation for each step was returned to the panel until consensus was reached. Consensus was defined as Cronbach’s a greater than 0.80. Surgical sub-steps that 80% of experts rated as 4 or 5 on a Likert Scale of 1 to 5 were included in the final instrument. Results: In the first round of the consensus survey Cronbach’s a was 0.81 for laparoscopic sigmoid colectomy, 0.77 for right (medial to lateral) laparoscopic colectomy, and 0.74 for right (lateral to medial) laparoscopic colectomy. In the second round it increased to 0.83 for medial to lateral laparoscopic right colectomy, and 0.82 for lateral to medial laparoscopic right colectomy. Conclusions: The Delphi method allowed the determination of expert consensus regarding the essential surgical sub-steps to be included in an evaluation tool designed to measure technical competence in laparoscopic colorectal surgery. The final technical skills assessment tool represents the consensus of experts in minimally invasive colorectal surgery from Canada, the United States, Europe, and Australia. This represents the initial step in outlining a rigorous methodology to define technical competence in laparoscopic colorectal surgery.
EMERGING TECHNOLOGY 1 39.1. Porous Polyvinyl Alcohol-Alginate Gel Hybrid Construct for Neocartilage Formation Using Human Naso-Septal Cells. D. A. Bichara, X. Zhao, H. BodugozSenturk, W. Ong, E. Oral, M. A. Randolph, M. J. Yaremchuk, O. K. Muratoglu; Massachusetts General Hospital, Harvard Medical School, Boston, MA
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* P < 0.05 The operating room is a fixed cost although operative time is a variable cost. In our institution, OR time costs approximately $25/min. The cost associated with a complication is difficult to define. Conclusion: Surgical procedures are significantly longer with residents. In many instances, there are significantly more complications in procedures with residents. The financial cost associated with resident education includes an increased cost for procedures due to an increase in operative time and an increase in complications.
38.8. Development of an Evaluation Tool to Assess Technical Skill in Laparoscopic Colorectal Surgery: A Delphi Approach. V. N. Palter, H. M. MacRae, T. P. Grantcharov; University of Toronto, Toronto, ON, Canada
38.7. The Cost of Resident Education. C. S. Hwang,1 K. A. Wichterman,2 E. J. Alfrey3; 1Stanford University, Stanford, CA; 2The Springfield Clinic, Springfield, IL; 3Southern Illinois University School of Medicine, Springfield, IL Introduction: Previous studies regarding the cost of resident education are conflicting. Most studies regarding surgical residents report single procedure costs at one institution. The National Surgical Quality Improvement Program (NSQIP) database has allowed insight into defining cost disparities associated with resident education. Materials and Methods: We compared demographic data, and then outcome data that contributes to cost from the NSQIP database for five procedures commonly performed by residents from 2005-2006 between patients cared with and without residents. We compared age in years, ASA class I-VI, total operating room time (OR time) in minutes (min), length of hospital stay in days (d), number of patients with a return to OR in 30 d, and complications. Comparisons were made using the unpaired Student’s t-test. Differences < 0.05 were considered significant. The five cases compared were laparoscopic (L) and open (Op) appendectomy (Appy), elective laparoscopic cholecystectomy (L-GB), mastectomy (mast), and elective colon resection (colon) between the resident Ò and no resident (NR) groups. Results: There were 32,685 patients evaluated in these five cases. In all comparisons, OR time was significantly longer, in three comparisons complications were higher, and in one instance LOS was longer in the resident groups.
Introduction: Laparoscopic colorectal surgery (LCS) is considered an advanced minimally invasive procedure. The long, variable learning curve for LCS, as well as evidence that patient outcomes may suffer early in the learning curve, necessitates that individuals learning LCS do so in a safe manner, with a means to objectively evaluate their performance before entering independent practice. To date no tools have been designed and validated to assess performance during LCS. Furthermore, to be widely useful, any tool developed must be reflective of practice across many institutions. Objectives: To design an objective technical skills assessment tool for laparoscopic colorectal surgery using a Delphi consensus methodology. Methods: This study utilized a Delphi methodology to achieve consensus through expert opinion on the essential steps for a laparoscopic sigmoid colectomy and laparoscopic right colectomy. These sub-steps were compiled from three sources: 1) University of Toronto faculty expert opinion 2) surgical textbooks 3) published peer-reviewed literature. Each expert was asked to rate the sub-steps on a Likert scale from 1 (strongly disagree) to 5 (strongly agree) with respect to the level that they believed that the step should be included in a final evaluation tool. In addition, participants were offered the opportunity to comment on each sub-step, or to clarify their ratings. The average and standard deviation for each step was returned to the panel until consensus was reached. Consensus was defined as Cronbach’s a greater than 0.80. Surgical sub-steps that 80% of experts rated as 4 or 5 on a Likert Scale of 1 to 5 were included in the final instrument. Results: In the first round of the consensus survey Cronbach’s a was 0.81 for laparoscopic sigmoid colectomy, 0.77 for right (medial to lateral) laparoscopic colectomy, and 0.74 for right (lateral to medial) laparoscopic colectomy. In the second round it increased to 0.83 for medial to lateral laparoscopic right colectomy, and 0.82 for lateral to medial laparoscopic right colectomy. Conclusions: The Delphi method allowed the determination of expert consensus regarding the essential surgical sub-steps to be included in an evaluation tool designed to measure technical competence in laparoscopic colorectal surgery. The final technical skills assessment tool represents the consensus of experts in minimally invasive colorectal surgery from Canada, the United States, Europe, and Australia. This represents the initial step in outlining a rigorous methodology to define technical competence in laparoscopic colorectal surgery.
EMERGING TECHNOLOGY 1 39.1. Porous Polyvinyl Alcohol-Alginate Gel Hybrid Construct for Neocartilage Formation Using Human Naso-Septal Cells. D. A. Bichara, X. Zhao, H. BodugozSenturk, W. Ong, E. Oral, M. A. Randolph, M. J. Yaremchuk, O. K. Muratoglu; Massachusetts General Hospital, Harvard Medical School, Boston, MA